1.Your details

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Title *
Ethnic origin *
Gender *
Religion *

2.Job role

For nurses only

3.Professional qualifications and experience

Highest qualification


I am willing to attend mandatory training/specialist training as and when required *

4.Employment history

Please add details of the past five years work history, starting with your current or most recently held position. You must state reasons for any breaks in employment.

Position 1

Position 2

Position 3

Position 4

Position 5

5.Work preferences

To enable us to place you in suitable environments, please indicate areas of choice and speciality.

Please check to indicate your shift preference *


Please supply names and contact addresses of at least two referees who are healthcare professionals and preferably hold a position more senior to your own.

One referee must be from your current or most recent place of employment.

Reference 1 details

Reference 2 details

Reference 3 details


Please provide PAYMENT DETAILS where you'd like to receive payment for your shifts.

8.Eligibility to work

Before you can work with Star Care Team, we will need to verify and take a copy of your original ID documentation as evidence of your right to work in the UK in accordance with Home Office guidance on the prevention of illegal working. Please pick ONE of the following option.

Do you have permission to work in the U.K? *

9.Rehabilitation offenders act

Please read the following statement:

"Because of the nature of the work for which you are applying, this post is exempt from the provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 and the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendment) Order 1986.

Applicants are, therefore, obliged to disclose information about any convictions which for other purposes would be regarded as ‘spent’ under the provisions of the Act”. Failure to disclose such convictions could result in dismissal or disciplinary action by the employing organisation. Any information given will be confidential and will be considered only in relation to any post to which the conviction applies.

Have you at any time received or had pending a court conviction in the UK or overseas? If yes, please give details. *
Are you aware of any police enquiries undertaken following allegations made against you, in the UK or overseas? *

10.Data Protection Act statement

We will process all data in compliance with the provisions of the Data Protection Act 1998. Please sign below to freely give your explicit consent to allow the information, given on this form, to be processed in accordance with Star Care Team's registration under the Data Protection Act 1998 for HR and payroll purposes, equal opportunities monitoring and to fulfil statutory requirements, including but not limited to Equalities Act 2010.

Please tick once you have read and understood the above Data Protection Act statement. *

11.Confidentiality statement

Registration implies acceptance of our code of confidentiality.

In the course duties undertaken, I may have access to confidentiality information about Clients. Under no circumstances must information relating to identifiable Client be divulged to anyone other than the manager of the agency, or bodies concerned with the welfare of individuals under the governance of the law. I will not disclose ANY information to my family, friends, or neighbours. If you are worried by any information you have obtained and consider that an individual is at risk, please notify your account manager and line manager on the shift immediately.

Failure to observe these rules will be regarded as serious misconduct which could result in removal from the agency platform.

Please tick once you have read and understood the above confidentiality statement. *

12.Working time regulations

The Working Time Regulations 1998 state that you are unable to work in excess of an average of 48 hours per week (calculated over a 17 week period) unless agreed with Star Care Team that this limit should not apply.

For the avoidance of doubt and for the purposes of the Regulations, the Agency Workers working time shall only consist of those periods during which she/he carries out activities or duties for the Client as part of an Assignment. Time spent travelling to the Client's premises; meal breaks and other rest breaks shall not count as part of the working time for these purposes.

Please select only ONE of the following options

13. Equal opportunities statement

Equal opportunity for all work seekers is of paramount importance at Star Care Team. As such, Star Care Team committed to a policy of equal opportunity, and shall adhere to non discriminatory practices at all times on all aspects of operation including recruitment and placement, and to unlawful or undesirable discrimination. Every worker will be treated equally regardless of race, ethnic or national origin, colour, sex, sexual orientation, disability, marital status, age, religion, political beliefs, offending history or membership or non-membership of a trade union and we require commitment from all staff and agency workers to respect and act in accordance with the policy.

Assessment of candidates will solely be based upon the candidates merits, qualification and ability to perform the relevant duties required by a particular vacancy.

Please tick once you have Read and Understood the above Equal Opportunities Statement. *
Do you consider yourself to have a disability under the Equality Act?

*The definition of disability according to the Equality Act 2010 is: "A physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities". A long term effect is one that has lasted 12 months, is likely to last 12 months or, is likely to last the rest of the person’s life.

14. Final Statement and Declaration

I hereby declare to the best of my knowledge that the information given above, including any supporting documents is true and correct.

I consent to my personal data and profile being forwarded to clients.

I consent to references being passed on to potential employers.

I consent to the processing of personal data, and for any enquiries to be made to confirm all matters concerning my application, and employment such as qualification, dates of employment, experience, Disclosure and Barring Services check, and health checks, and for the release by other people and organisations for that information might be necessary for that purpose.

I understand that false information might lead to your dismissal from the Star Care Team Flex platform.

If during the course of a temporary assignment, the Client wishes to employ me direct, I acknowledge that Star Care Team will be entitled either to charge the client an introduction/transfer fee, or to agree an extension of the hiring period with the Client (after which I may be employed by the Client without further charge being applicable to the Client).

I understand that acceptance on to the Star Care Team Flex platform may only be granted after relevant checks are made, satisfactory references are received and I have attended a Face to Face interview.

I hereby consent to pre-employment screening checks will take place. I consent for such checks to be performed and acknowledgement that any failure to provide accurate information may result in my application not being taken forward.

I consent to a 3rd Party Audit, complete DBS Check, DBS Update Service Checks, to retain DBS on file, to obtain references, to complete PIN Checks, Right to Work and Identity Checks, to complete Training record checks, to complete Occupational Health checks, to complete Qualification Checks, Confirmation of receipt of AWR information (including Day 1 Rights)

Final statement and declaration Please tick once you have Read and Understood the above Statement and Declaration. *

15. Health self declaration

PLEASE NOTE: If you falsify any information on this form, or fail to mention anything relating to your health which may later come to light, you may be liable for immediate suspension from the platform.

You are required to complete the Health Self Declaration Assessment below which must be signed and returned to Star Care Team prior to the start date

Do you have any illness/impairment/disability (physical or psychological) which may affect your work, your own health, safety and welfare, or that of others?* *
Are you having, or waiting for treatment (including medication) or medical investigation at present? *
Do you think you may need any adjustments or assistance to help you to do the job? *
Do you have any of the following? *

As a health care worker, you are under ethical and legal duties to protect the health and safety of the individuals in your care. All information disclosed will be processed in accordance with the requirements of the Data Protection Act.

Have you ever had chickenpox/varicella? *
Can you provide documented evidence of immunity to measles, mumps and rubella? *
Have you had a BCG vaccination in relation to tuberculosis?* *
Have you had a Hepatitis B test in the last 5 years?* *

Please provide proof of your immunisation record This can be obtained from your GP or local  travel clinic.

Choose File
I declare that all of the information provided regarding my declaration of health and immunisation record is true to the best of my knowledge and I will endeavour to inform Star Care Team of any change in my health circumstances that may affect my ability to carry our any shift booked. *